Abstract
Expandable metallic stent (EMS) have been frequently employed for the treatment of airway stenosis due to various causes. However, it has been clear that there are some problems associated with EMS. We experienced 3 kinds of problems in 4 out of 6 patients treated by EMS in our hospital. These troubles were (1) intractable cough caused by the irritation caused by the mesh sutured around the EMS to block the intraluminal growth of tumor, (2) fatal intratracheal bleeding due to the injury caused by the EMS, (3) intraluminal growth of lung cancer through the wires of the EMS. All of these problems restricted us from employing EMS without careful consideration. Coughs described in previous reports were not severe, but our case suffered obstinate cough until death in spite of administration of many kinds of antitussive agents. After this experience we did not use a mesh-covered EMS again. Two cases died of intratracheal bleeding. Autopsy performed in one patient revealed the bleeding from the tracheal mucosa injured by the EMS wire. Embolization of the bronchial artery was ineffective in this case. If EMS could have been safely extracted, this complication could be avoided. Tumor growth through the net of the wires of EMS brought about severe stenosis and one patient almost asphyxiated, but the emergency insertion of a Dumon stent into the lumen in the EMS saved the life of the patient. EMS has the excellent feature of early insertion, but our experience taught us the limited clinical indications of EMS. EMS should be employed only in terminal stage patient whose airway is narrowed by extraluminal compression due to tumor.
